Table 4 Caregiver themes across the 5A taxonomy and how they changed over time
5A domains | Key themes from caregivers | Changes over time |
|---|---|---|
Awareness | • Low awareness of the malaria vaccine • Incorrect information about eligibility or delivery point of the vaccine | ➔ low awareness led to initial delays to get dose-1 but awareness of the vaccine grew over time ➔ incorrect information about eligibility and the delivery point persisted over time and led to delays that pushed children beyond eligibility |
Acceptance | • Hindered by fears related to side effects from previous immunisations - infants get ‘too many’ injections • Hindered by concerns that the malaria vaccine is new and being tested • Facilitated by attitudes that vaccines in general are good and effective • Facilitated by perception that the new malaria vaccine is effective | ➔ experiences with previous side effects initially delayed dose-1 uptake but this fear subsided over time due to perceived lived benefits of the vaccine & positive messages from peers about the vaccine ➔ malaria vaccine specific concerns caused initial delay, but fears were overcome due to repeated messages at the health facility ➔ attitude that vaccines are generally good persisted across all interviews ➔the perception that the malaria vaccine is effective and protects children grew over time |
Access | ||
 Individual level (I) | • Burden of getting to the health facility was an access barrier • Competing life events delayed uptake of the vaccine | ➔ inconvenience of getting to the facility (with multiple infants or while pregnant) delayed uptake of dose-1 ➔ work, travel away or illness contributed to initial delays in getting dose-1 |
 Health system (HS) | • Negative provider attitudes discouraged attendance at immunisation services • Immunisation services not available (provider strikes, service schedule) • Barriers related to vaccine stockout at the facility-level | ➔ delays persisted for some caregivers because of fears that their providers would scold them for being late, missing doses or not having their MCHa booklet ➔ unavailable services or vaccines persistently frustrated caregiver attempts to take up the vaccine |
Affordability | • Transportation costs to get to the facility was an uptake barrier | ➔ having to find or not having transportation money increased the burden of getting to the health facility |
Activation | • Promoted messages about the new malaria vaccine at health facility • Screening by provider that captures missed immunisations provided new opportunities to initiate dose-1 | ➔ messages about the malaria vaccine encouraged uptake of dose-1 ➔ some eligible children received dose-1 because of provider screening for missing immunisations during a facility visit for other reasons |